瑞芬太尼复合异丙酚靶控输注时抑制喉应激反应的有效靶浓度

THE TARGET CONCENTRATIONS OF REMIFENTANIL COMBINED WITH PROPOFOL BY TARGET CONTROLLED INFUSIONS FOR SUPPRESSION OF THE MOVEMENT RESPONSES TO LARYNGOSCOPY

目的在靶控输注(target-controled infusion,TCI)异丙酚3μg/mL基础上,测定TCI瑞芬太尼抑制喉应激反应的有效浓度。方法 30例全麻拟行择期手术的患者,美国麻醉医师协会体格情况分级Ⅰ～Ⅱ级,体质量指数<30,年龄27～60岁,肝肾功能正常。全麻诱导,TCI血浆浓度异丙酚3μg/mL,瑞芬太尼初始TCI效应室浓度1.5 ng/mL,采用等阶(0.5ng/mL)增加或减少靶浓度,待患者意识消失,血浆和效应室靶浓度平衡3min后,进行喉镜显露声门刺激,获取每例患者无反应的瑞芬太尼靶浓度。结果喉镜暴露声门无反应的瑞芬太尼有效靶浓度为(2.3±0.3)ng/mL。结论异丙酚和瑞芬太尼双靶控输注能消除麻醉中的伤害性刺激,当异丙酚靶浓度3μg/mL时,瑞芬太尼抑制喉镜窥喉显露声门刺激的有效靶浓度为(2.3±0.3)ng/mL。

Objective To investigate the target concentrations of remifentanil administered by target-controled infusion（TCI） for suppression of the movement responses to laryngoscopy during TCI propofol （plasma concentration of 3 μg/mL）. Methods Thirty patients whose body mass index〈30,between 27 to 60 years old and with normal hepatic fanction and renal function were scheduled for selective surgery under the total intravenous general anesthesia. Anesthesia was induced with the target controlled infusions of propofol and remifentanil. On the basis of the target effective concentration of 1.5 ng/mL, remifentanil was given at 0.5 ng/mL staircase to increase or decrease the target concentrations till no movement to the laryngoscopy were obtained for each patient during TCI propofol （3 μg/mL）. The mean of target effective concentrations of remifentanil on the laryngoscopy responses was calculated. Results Target effective concentration of remifentanil for suppression of movement response to laryngoscopy was （2.3±0.3） ng/mL. Conclusion Remifentanil combined with propofol TCI can eliminate invasive stimulation. The target effective concentration of remifentanil for suppression of response to laryngoscopy was （2.3±0.3） ng/mL at TCI when the target concentration of propofol was 3μg/mL.